Medicare’s open enrollment begins this month, and Georgia residents are weighing their options for coverage – either a government-run Medicare or private sector managed Medicare Advantage. A recent study by the Journal of the American Medical Association (JAMA) Health Forum found that those seniors enrolled in Medicare Advantage received a higher quality of care than those enrolled in traditional Medicare. In fact, according to the study, Medicare Advantage beneficiaries received 9.2 percent fewer needless, wasteful services than traditional Medicare enrollees.
This comes at a time of historic inflation and when Georgians are looking for any cost saving measure they can find. They are already dealing with the rising costs of healthcare and seem to be increasingly opting for Medicare Advantage over what’s known as traditional “fee-for-service” Medicare.
The study shows that the majority of seniors eligible for the coverage want the ability to choose options that meet their personal health care needs and provide reliable access to high-quality care at a price they can afford. For most beneficiaries, easy access, choice, and flexibility are critical to their health care outcomes. What many don’t know is that, despite its promise that “beneficiaries may see any provider who accepts Medicare,” nearly 10,000 doctors across the country choose not to accept FFS Medicare due to its unsustainable provider reimbursement rates compared to Medicare Advantage.
The study examined data from nearly 2.5 million Medicare beneficiaries. It found that Medicare Advantage beneficiaries had lower rates of low-value services across all six clinical categories that the study’s authors examined. Low-value care includes “tests, treatments, and procedures that provide little to no clinical benefit,” the study said – adding that low-value care “is a widespread and costly source of waste, inefficiency, and potential harm in the U.S. healthcare system.”
According to research, Fee-for-Service Medicare beneficiaries pay approximately $1,965 more per year in total health care related expenditures than beneficiaries in Medicare Advantage. Research from Harvard University and the Commonwealth Fund shows:
● 53 percent of “seriously ill” FFS Medicare beneficiaries reported having a significant problem paying a medical bill of any kind;
● 30 percent reported difficulty paying for their prescription drugs;
● 5 percent reported difficulty paying hospital bills;
● 36 percent used up all or most of their savings on health care related costs
● 23 percent were unable to pay for necessities such as food, heat and housing because of their medical costs; and
● 45 percent reported emotional or psychological distress due to the underlying issues.
Notably, the study points out that FFS Medicare also does not provide beneficiaries with an annual limit out-of-pocket expenses – leaving seniors to face uncertainty when it comes to their health care costs.
Reports indicate that 95 percent of Medicare Advantage beneficiaries are satisfied with their network of doctors, hospitals and specialists. Also, approximately 88 percent (and growing) of beneficiaries relay that Medicare Advantage allows them the choice and flexibility to see the doctors they want, when they want, and on their own terms. Kaiser Family Foundation previously found that compared with Medicare Advantage, 11 percent fewer beneficiaries in traditional Medicare receive their flu vaccine and 49 percent fewer beneficiaries receive their pneumonia vaccine, according to a 2020 data analysis by Avalere Health.
The bottom line, many point out, is that Medicare Advantage is saving federal dollars compared to FFS Medicare. Reports show that the federal government spends roughly $7 more per-member, per-month in FFS Medicare than it does for beneficiaries of a similar health status in Medicare Advantage, ($949.39 in FFS Medicare vs. $942.43 in Medicare Advantage).
